ASVMEB Order 18018 EDWIN KIESEL, DVM

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BEFORE THE ARIZONA STATE VETERINARY MEDICAL
EXAMINING BOARD

IN THE MATTER OF: Case Nos.: 18-16 and 18-18

FINDINGS OF FACT,
CONCLUSIONS OF LAW

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EDWIN KIESEL, DVM
) AND ORDER
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Holder of License No. 1360

For the practice of Veterinary
Medicine in the State of Arizona,

Respondent.

On February 21, 2018 and March 21, 2018, the Arizona State Veterinary
Medical Examining Board conducted an Informal Interview regarding Edwin
Kiesel, DVM (“Respondent”). The proceedings in this matter are governed by
A.R.S. § 32-2234 (A). Respondent was advised of his right to legal counsel by
letter, appeared, and participated in the Informal Interview with counsel, David
Stoll. The Board reviewed all documents submitted regarding this matter, took
testimony from Respondent, and proceeded as is permitted by A.R.S. § 32-2234
(A).

Following the Informal Interview and the Board’s discussion of the
information and documents submitted, the Board determined that
Respondent's conduct constituted medical incompetence pursuant A.R.S. §
32-2232 (22) and ARS § 32-2232 (21) medical record keeping. After considering
all of the information and testimony, the Board issues the following Findings of

Fact, Conclusions of Law and Order, (“Order”).

FINDINGS OF FACT

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1. Respondent is the holder of License No. 1360 issued on June 13, 1981, and
is therefore authorized to practice the profession of veterinary medicine in the
State of Arizona.

18-16:

2. On May 31, 2017, “Gabby,” a 7-year-old female domestic short hair cat
was presented to Respondent due to ocular and nasal discharge. According
to Complainant, Respondent advised her that the cat had a bad tooth that
needed to be extracted, explaining that teeth and nasal cavity are connected
and the cat would continue to get worse until the tooth was removed. Upon
exam, the cat had a weight = 10.9 pounds, a temperature = 101.9 degrees, a
heart rate = 180bpm and a respiration rate = 40rom; BP = 218/156. Respondent
noted that the cat had discharge coming from the right eye and right nasal
passage. He further noted that the cat had a bad tooth in the back right side
of the mouth; therefore, he recommended antibiotics and a dental procedure.

3. A Schirmer tear test was performed: Left eye -23; Right eye — 28.
Amoxicillin drops and Tobramycin ophthalmic solution were dispensed and the
cat was discharged. Complainant made an appointment for the cat’s teeth to
be evaluated and possible extractions.

4. On June 8, 2017, the cat was presented to Respondent for tooth
extraction. Blood was collected and revealed an elevated BUN (42) and
Creatinine (2.2). Respondent thought it would be best to hold off on surgery
due to the cat's kidney. values. He contacted Complainant’s husband and
explained that anesthesia was a greater risk due to the elevated kidney values

and wanted to put the cat on a special diet and recheck in a week. ‘

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5. On July 15, 2017, the cat was presented to Respondent for a tooth
extraction. The cat had a temperature = 101.2 degrees, a heart rate = 169bpm
and a respiration rate = 45rom (no weight noted) just prior to placing in box to
anesthetize; out of box, the cat had a temperature = 102 degrees, a heart rate
= 150bom and a respiration rate = 30rom. No other systems were noted as
being examined.

6. According to Respondent, he held the edi and used a mask to
anesthetize her (type of anesthesia unknown); the cat was not intubated. He
cleaned the teeth but since the renal values were high and the infection
appeared under control, he did not want to stress the cat further by extracting
teeth. The medical record reads that the teeth were in good shape; only the
upper left molars were bad with calculi and pa gums. The calculi was broken
off using a ronguer and an electronic scaler. The teeth were quickly polished as
the cat was waking. No IV or SQ fluids were administered. Recovery was
uneventful (T = 101.4, P - 155, R — 45). Authorization to perform surgery was not
obtained.

7. According to Complainant, when she arrived to pick up the cat, she was
told the cat was administered an antibiotic injection that would last 10 days.
There are no notations in the medical record that the cat was administered an
injection. Discharge instructions were not documented in the medical record.

8. On July 26, 2017, the cat was presented to Respondent for a recheck as
the cat was progressively getting worse, not eating, and losing weight.
According to Complainant, staff member Mary examined the cat and advised
that Respondent would be in shortly. Approximately an hour later, Mary

returned to explain that Respondent wanted the cat to stay overnight as he

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thought a tooth fragment had been left behind and he would like to
anesthetize her again to evaluate the area. Complainant approved and left
the cat without speaking with Respondent.

9. The following day (7/27), blood work was performed. Respondent noted in
the medical record that there was a light yellow mucoid discharge coming
from the right nostril and teeth looked fine but only a radiograph could tell
them for sure and anesthesia would be needed for that. Respondent further
documented that the blood work showed the cat was now anemic with a PCV
= 19% (HCT on lab strip = 38.22%); therefore, would bypass the anesthesia and
radiographs for now and try convenia again with tobramycin nasally; if the
problem became chronic, he would need radiographs under anesthesia.

10. However, Respondent stated in his narrative that he elected to
anesthetize the cat again with isoflurane; the mouth looked fine and he would
have pulled teeth at this time but now the blood work showed that the cat was
anemic. Authorization to perform surgery was not obtained.

11. Respondent's medical records show surgical monitoring that the cat was
anesthetized for 30 minutes. The medical record reads that Respondent was
not able to take radiographs which would be what they may need and can be
done later if this does not work. Respondent cleaned teeth but there was no
real tartar build up or gum disease and no exposed roots —- may need deeper
anesthesia to get radiographs and remove teeth. The cat was administered
convenia 80mg/mL, 0.4mL - route unknown, and dispensed Tobramycin -
apply one drop between nostrils three times a day.

12. According to Complainant, after leaving numerous messages, she was

finally called and told the cat was doing well and could be picked up. When

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18-16 and 18-18, Edwin Kiesel, DVM

she arrived at the premise, she was handed the cat with no information on why
the cat was not getting better. Respondent walked out into the lobby to adjust
the thermostats and turn the lights off; therefore, Complainant asked what he
found. Respondent told her that the congestion was a residual to the tooth
being pulled and would subside in about a week. Another antibiotic injection
was given along with nose drops to take home. No discharge instructions were
documented in the medical record.

18-18:

13. On ‘August 18, 2016, “Angel,” a 1.5-year-old female domestic medium
hair feral cat was presented to Respondent for an exam, vaccines, ear tip, and
spay procedure. According to Respondent, the cat was too feral to examine,
therefore the cat was anesthetized. There is no documentation in the medical
record what was used to anesthetize the sae nor was any monitoring for the
duration the cat anesthetized. Upon exam, the cat had a weight = 6.7 pounds,
a temperature = 103 degrees, a heart rate = 154bom and a respiration rate =
30rom; BP = 154/80. Respondent noted that the cat had thick nasal discharge
with blood. Due to the nasal discharge and elevated temperature, Respondent
elected to wait until the cat was feeling better before spaying. The cat was
administered a convenia injection (amount, strength and route unknown) and
treated with tobramycin ophthalmic solution; the cat was kept at the premise in
isolation.

14. The medical record reads that the cat was weighed and examined
every day, including a temperature, heart rate, respiration rate and blood
pressure, as well as being administered tobramycin to the nostrils, despite the

cat being feral. Previously, Respondent stated the cat could not be examined

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unless the cat was anesthetized. Interestingly, the daily documented
temperature, pulse, respiration rate and blood pressure did not fluctuate much.
The August 20, 2016 entry is stamped that Respondent edited the entry on July
13.2017.

15. On September 1, 2016, the record reads that Complainant called and
was advised that the cat was not spayed that day due to the continued
elevated temperature and bloody nasal drainage. Complainant was told that
the cat was given an antibiotic injection which would be good for 2 weeks
(unclear if this the second antibiotic injection the cat received). Complainant
elected to take the cat home to monitor and bring back to be spayed.
According to Complainant, he was advised that the cat was spayed.

16. 4. It is not clear if the cat was vaccinated or if the ear was tipped at this
time.

17. On October 26, 2016, according to Complainant, the cat gave birth to
three kittens. The Complainant called Respondent and was advised that the
cat must have been pregnant prior to being spayed.

18. Complainant stated the cat had another litter of kittens in October 2017.

19. On August 31, 2017, the cat was presented to Santa Cruz Veterinary
Hospital for an exam. Complainant explained that the cat was brought to
Respondent's premise to be spayed, but the cat had kittens. The medical
record lists the cat as a 1-year-old female domestic short hair cat.

20. Medical record reads that the cat could not be examined due to being
feral; therefore, the cat was anesthetized. It was noted that the cat had a flank
scar and the left ear was tipped; the abdomen was distended. Surgical notes

read that the right ovary was scarred down and was bluntly dissected out. The

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right kidney appeared normal. The right ovary was removed and the abdomen
was closed.
CONCLUSIONS OF LAW

21. The Arizona State Veterinary Medical Examining Board has jurisdiction
over this matter pursuant to A.R.S. § 32-2201, et seq.
18-16:

22. The conduct and circumstances described in the Findings of Fact above,
constitutes a violation of A.R.S. § 32-2232 (22) Medical incompetence; lacked
sufficient knowledge or skill to a degree likely to endanger the health of the cat
as demonstrated by the inability to intubate the cat or place an IV catheter
and proceeded with the dental cleaning.

23. The conduct and circumstances described in the Findings of Fact above,
constitutes a violation of A.R.S. § 32-2232 (21) as it relates to A.A.C. R3-11-502
(E) no discharge instructions documented in the medical record on July 15,
2017 or July 27, 2017.

24. The conduct and circumstances described in the Findings of Fact above,
constitutes a violation of A.R.S. § 32-2232 (21) as it relates to A.A.C. R3-11-502
(H) (1) no signed authorization was obtained before general anesthesia was
administered or surgery was performed on July 15, 2017 or July 27, 2017.

25. The conduct and Greumsanees described in the Findings of Fact above,
constitutes a violation of A.R.S. § 32-2232 (21) as it relates to A.A.C. R3-11-502 (L)
(4) no results of an exam documented in the medical record on July 15, 2017.
18-18:

26. The conduct and circumstances described in the Findings of Fact above,

constitutes a violation of A.R.S. § 32-2232 (21) as it relates to A.A.C. R3-11-502 (L)

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(b) failure to document in the medical record the amount of the convenia
administered to the cat on August 18, 2016.

27. The conduct and circumstances descibed in the Findings of Fact above,
constitutes a violation of A.R.S. § 32-2232 (21) as it relates to A.A.C. R3-11-502 (L)
(d) failure to document in the medical record the route of administration of the

convenia administered to the cat on August 18, 2016.

ORDER

Based upon the foregoing Findings of Fact and Conclusions of Law it is
ORDERED that Respondent's License, No. 1360 be placed on PROBATION for a
period of two (2) years, subject to the following terms and conditions that shall
be completed within the Probationary period. These requirements include
fourteen (14) total hours of continuing education (CE) and a civil penalty
detailed below:

1. IT IS ORDERED THAT Respondent shall provide written proof satisfactory
to the Board that he has completed six (6) hours of continuing education (CE);
hours earned in compliance with this order shall not be used for licensure
renewal. Respondent shall satisfy these six (6) hours by attending CE in the area
of anesthesia. Respondent shall submit written verification of attendance to the
Board for approval prior to the end of the Probation period.

2. IT IS ORDERED THAT Respondent shall provide written proof satisfactory
to the Board that he has completed four (4) hours of continuing education
(CE); hours earned in compliance with this order shall not be used for licensure

renewal. Respondent shall satisfy these four (4) hours by attending CE in the

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area of client communication. Respondent shall submit written verification of
attendance to the Board for approval prior to the end of the Probation period.

3. IT IS ORDERED THAT Respondent shall provide written proof satisfactory
to the Board that he has completed four (4) hours of continuing education
(CE); hours earned in compliance with this order shall not be used for licensure
renewal. Respondent shall satisfy these four (4) hours by attending CE in the
area of veterinary ethics as applied to client communication. Respondent shall
submit written verification of attendance to the Board for approval prior to the
end of the Probation period.

4, IT 1S FURTHER ORDERED THAT Respondent shall pay a civil penalty of one
thousand seven hundred fifty dollars ($1750) on or before the end of the
Probation period. {This total amount represents two-hundred fifty dollars ($250)
per each of the five medical record violations and five hundred dollars ($500)
for the medical incompetence violation.} The civil penalty shall be made
payable to the Arizona State Veterinary Medical Examining Board and is to be
paid by cashier’s check or money order.

5. All continuing education to be completed for this Order shall be pre-
approved by the Board. Respondent shall submit to the Board a written outline
regarding how he plans to satisfy the requirements in paragraphs 1, 2, and 3 for
its approval within sixty (60) days of the effective date of this Order. The Suiting
shall include CE course details including, name, provider, date(s), hours of CE to
be earned, and a brief course summary.

6. Respondent shall obey all federal, state and local laws/rules governing
the practice of veterinary medicine in this state.

7. Respondent shall bear all costs of complying with this Order.

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8. This Order is conclusive evidence of the matters described and may be
considered by the Board in determining an appropriate sanction in the event a
subsequent violation occurs. In the event Respondent violates any term of this
Order, the Board may, after opportunity for Informal Interview or Formal
Hearing, take any other appropriate disciplinary action authorized by law,

including suspension or revocation of Respondent's license.

REHEARING/APPEAL RIGHTS

Respondent has the right to petition for a rehearing or review of this Order.
Pursuant to A.R.S. § 32-2234 (H) and § 41-1092.09 the petition must be filed with
the Board within thirty-five (35) days from the date of mailing if the Order was
served via certified mail. Pursuant to A.A.C. R3-11-904 (C}, the petition must set
forth legally sufficient reasons for granting the rehearing or review. The filing of
a petition for rehearing or review is required to preserve any rights of appeal to
the Superior Court that the party may wish to pursue.

This Order shall be effective and in force upon the expiration of the above
time period for filing a motion for rehearing or review with the Board. However,
the timely filing of a motion for rehearing or review shall stay the enforcement
of the Board’s Order, unless, pursuant to A.A.C. R3-11-904 (F), the Board has
expressly found good cause to believe that this Order shall be effectively

immediately upon the issuance and has so stated in this Order.

WA
Dated this_ 29%" _ day of 77z#4_, 2018.

Arizona State Veterinary Medical Examining Board
Jim Loughead
Chairman

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By:

Victoria Whitmore, Executive Director

Original of the foregoing filed this gah day of VI ZZS , 2018

with the:

Arizona State Veterinary
Medical Examining Board
1740 W. Adams St., Ste. 4600
Phoenix, Arizona 85007

Copy of the foregoing sent by certified, return receipt mail
this 27 day of _7Zae4£— , 2018 to:

Edwin Kiesel, DVM:
Aadaress on file
Respondent

Copy of the foregoing sent by regular mail

this 27 day of P2axcL— _, 2018 to:

David Stoll, Esq.

Beaugureau, Hancock, Stoll and Schwartz, PC
302 E. Coronado Rd

Phoenix, Arizona 85004

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Board Staff

By:

BR

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